Small bowel volvulus over acute bowel invagination: laparoscopic management
Epublication WebSurg.com, Nov 2013;13(11). URL: http://websurg.com/doi/vd01en4070
Digestive angiodysplasia is a condition defined by an innate alteration of digestive wall vascular structures, which has been well-described since the development of endoscopy. Its cause is not well known and most occurrences are probably innate. Digestive angiodysplasias can be isolated or multiple. They most frequently affect the right colon, and more rarely the stomach, the duodenum and the small bowel. They are the most frequent cause of occult digestive hemorrhage (30 to 40% of cases) and can more rarely cause occlusive episodes through intestinal invagination, linked to a voluminous angiodysplasia lesion. Here we describe the case of a girl treated for colonic angiodysplasia lesions. She was admitted to our intensive care unit for an occlusive syndrome. CT-scan helped to diagnose a small bowel invagination and decision is made to treat this patient laparoscopically. More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010. Colonoscopy at this time allowed to find three lesions of 5 to 8mm in diameter. A yearly colonoscopy control is performed. The patient was admitted to the intensive care unit for an occlusive syndrome with abdominal pain. Abdominal ultrasonography suggested an invagination which was confirmed by injected CT-scan. Decision was made to perform a laparoscopic exploration for a disinvagination or a bowel resection.